Provider Demographics
NPI:1336794148
Name:HEALING THROUGH ART
Entity Type:Organization
Organization Name:HEALING THROUGH ART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-209-4718
Mailing Address - Street 1:3521 LAKE AVE # B1
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5536
Mailing Address - Country:US
Mailing Address - Phone:260-209-4718
Mailing Address - Fax:
Practice Address - Street 1:3521 LAKE AVE # B1
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5536
Practice Address - Country:US
Practice Address - Phone:260-209-4718
Practice Address - Fax:260-572-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty